Clinical standards for the assessment, management and rehabilitation of post-TB lung disease

Abstract

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

Tuberculosis and COVID-19 co-infection: description of the global cohort

“…An issue which recently gained increasing interest is that of Post-TB Lung Disease (PTLD), as 13–68% of new TB cases and 75–96% of patients with MDR-TB completing anti-TB treatment suffer from TB sequelae [ 30 , 31 ]. This condition [ 30 , 31 , 33 – 36 ] includes obstructive, restrictive or mixed-pattern lung function abnormalities, reduced exercise capacity and impaired Quality of Life (QoL). A summary of clinical standards to adequately manage PTLD, which includes post-treatment evaluation and identification of patients with sequelae likely to benefit from pulmonary rehabilitation has recently been published [ 36 ].…”

“…This condition [ 30 , 31 , 33 – 36 ] includes obstructive, restrictive or mixed-pattern lung function abnormalities, reduced exercise capacity and impaired Quality of Life (QoL). A summary of clinical standards to adequately manage PTLD, which includes post-treatment evaluation and identification of patients with sequelae likely to benefit from pulmonary rehabilitation has recently been published [ 36 ].…”

Post-tuberculosis sequelae and their socioeconomic consequences: worth investigating

“…Post-tuberculosis sequelae are present in up to 60–90% of patients, who experience exercise limitations and have a hampered quality of life. 4 , 5 This post-acute phase was recently defined as post-tuberculosis lung disease. 4 , 5 …”

“…Among others, post-tuberculosis lung disease can be inadequately diagnosed or reported, since surveillance systems do not follow up patients after tuberculosis is declared cured in most countries. 4 , 5 …”

“…First, traditional tuberculosis control activities (prevention, diagnosis, treatment) need to be fine-tuned to prevent post-tuberculosis lung disease, and whenever possible to diagnose and manage it as early as possible. 4 , 5 Second, a clear direction for future research priorities has emerged. These include, among others, the understanding of the biological mechanisms leading to post-tuberculosis lung disease, the different aspects of this condition, the ideal strategies to diagnose post-tuberculosis lung disease at the completion of tuberculosis treatment, the potential role of rehabilitation, and the impact on patients' quality of life and on their survival.…”